TSH in the medicated elderly (70+)

[Lunario]

I have a question, mainly for the older ones among us (70+).

My mother has hypothyroidism, probably due to Hashimoto's, which also affects her sister, as well as my sister and me.

Of course, once again, only TSH was measured, no fT3, no fT4, let alone TPO-Ab or Tg-Ab.🙄

After years, she is still on a starter’s dose of 50 µg T4. She will be 80 years old next February, and her TSH is 4.25 (0.27–4.2).

That's quite a long way from a TSH level of around 1. It's always said that a higher TSH level is tolerated in older people - why is that? Isn't that just nonsense? I doubt that this applies to people who are under therapy.

Her sister is turning 70 soon, and I know for a fact that her TSH is around 1.

Of course, it's difficult to say anything without the free's, but my question to the slightly older among us is: is such a TSH level acceptable to you?

I have a strong suspicion that her fT3 is too low, and her cognitive abilities sometimes suffer a bit. Yes, she is a senior, but I refuse to dismiss the moments of brain fog as a dementia development or anything like that. Also, her high liver enzymes indicate decreased metabolic processes. Unfortunately, my Mom lives about 300 km away from me, and now I have the problem of having to convince her doctor to always measure the free values and increase the dose.

Are there any papers (e.g., at "Frontiers in Endocrinology" or "PubMed") that would be helpful?

Thank you very much.

[jimh111]

TSH is higher in older people and those with a higher (normal) TSH live longer. We can only guess what's happening - here are my guesses.I suspect TSH gets higher because the thyroid gets weaker and needs more bashing to secrete enough hormone. A consequence of a higher TSH in this situation is a high fT3 / fT4 ratio. We know that higher T4 levels are associated with increased mortality. So, my guess is a higher TSH gives a lower fT4, a higher fT3 and better health.

There is perhaps also the consideration that older people might have a lower TSH (and fT3) because they are in poor health, low T3 syndrome.

This doesn't really apply to patients with primary hypothyroidism because there isn't a healthy thyroid to bash. The elevated TSH is reflecting low fT3, fT4. So, I would go by symptoms and the frees. I don't think TSH is as reliable (if ever) in the elderly.

[HandS]

I am 71 with TSH of 0.8 and I would not function on numbers above that - but I take Lio and Levo.

But everyone is different.

I suggest you document the symptoms you are concerned about that could be improved with more thorough testing and increased medication . Ask her doctor to investigate those to begin with.

I understand the difficulty you face with the distance.

[asiatic]

A couple of papers that might be of interestElevated TSH in older adults

pmc.ncbi.nlm.nih.gov/articl...

Age modifies the TSH

pubmed.ncbi.nlm.nih.gov/173...

[Lunario in reply to asiatic]

Thank you very much. That looks useful. I hope it will help.

[greygoose]

I'm 79 and I haven't seen my TSH for years! Totally suppressed. Zero. And god help the medic that suggests it should be near 4! I'd eat him alive!

l don't think anybody says that the elderly 'tolerate' a higher TSH, that would be a weird thing to say because it's got nothing to do with tolerance. What they say is that healthy elderly people naturally have a slightly higher TSH. But the important word here is 'slightly'. Over 4 would be too much for anybody. And it certainly doesn't apply to people on thyroid hormone replacement because once you're hypo all the 'normal' rules fly out the window and you have to learn to live with a new way of being.

The problem is two fold:

a) doctors do not understand what TSH is or what it does. They seem absolutely clueless about the fact that the TSH follows the thyroid hormone level. And, in a healthy person gives a message to the thyroid to make more thyroid hormone when the pituitary decides that levels are too low. And that's about all it does. So, when your thyroid is missing, or you're on thyroid hormone replacement, you don't need TSH because there's nothing it can do.

b) the aim of the NHS is to diagnose as few people as possible with hypothyroidism and to treat them with as little hormone as possible. They do not like diagnosing and treating hypos. So, this idea of a higher TSH in elderly people is just another excuse for not diagnosing or treating elderly people correctly. Any excuse is good enough and to hell with the patient!

So, yes, your mother is under-treated and her doctor is being negligent. She should be on more than 50 mcg levo, and her TSH should come down to 1 or under like any other hypo's. And her FT3 is bound to be low on such a low dose, as well as her FT4. But apart from putting the fear of god into her GP if he doesn't increase it, the only other thing you can do is buy levo on-line so that she can increase it herself.

[Lunario in reply to greygoose]

Thank you very much for your detailed reply. You speak from the heart, and your comments are all too familiar. I totally agree with you!

I no longer care about my TSH level, either. At least not too much. I know that since I've been taking supplemental T3, I can go back to working in the garden for a whole day without being completely exhausted for the next two days or desperately needing a break after 20 minutes of piano lessons because my brain feels like a wet bun.

I hope this will serve as one example of several when I write a letter to her doctor.

However, I would still appreciate it if you could send me a PM and tell me a trusted source where I can buy Levo if needed.

If there's one thing I've learned since my diagnosis, it's that doctors are often very unhelpful and that you have to inform and help yourself. Still, I hope that I can convince her doctor to run all the necessary tests and increase her dose. I am also in the process of collecting sources for papers that will underline this. Professor Rudolf Hoermann, for example, is a coryphée in this field. Many doctors, and especially endocrinologists, could take a leaf or more out of his book.

[greygoose in reply to Lunario]

I'm afraid I can't help you with the levo, I don't take it. Sorry.

[Lunario in reply to greygoose]

Thank you anyway. And yes, "eat him alive" gave me a laugh, too.

[Nellie2016 in reply to greygoose]

You always make me chuckle greygoose eat him alive ! Ha ha

[greygoose in reply to Nellie2016]

[Ellie-Louise]

I just turned 78, my TSH has been 0.03 for years, and I’m not in bad health.

I am on Levo only.

[Lilian15]

I shall soon be 86. I wont go into long details, but I have been taking (what doctors would call) a large dose of T3 (bought privately) together with T4 (prescribed) and have been for the last 25 years. When my TSH goes up to 1.6 I am really ill. All the time I have been taking T3 my TSH has been, and still is 0.01. An endo once said I might have secondary hypothyroidism as well and primary, but did nothing about it and even missed telling GP. I am at risk of heart attack, or osteoporosis, because of my age, my weight, diabetes etc. yet I am still told the T3 can give me a heart attack and/or osteoporosis. I have known many people much younger than me, and much slimmer than me, who have died of a heart attack, or have osteoporosis who have never ever had a thyroid problem. Everyone is individual so I can only speak from my own experience, but I hope it helps.